<style type="text/css" media="screen">

    .weui-cells__title{
        color:#000;
        font-size:17px;
    }
    .weui-cell::before{
      border-top:none;
    }
    .weui-cells::before{
      border-top:none;
    }
    .weui-cells::after{
        border-bottom: none;
    }
    .my-weui-cell{
        /* border-top: 1px solid #e5e5e5; */
        border-bottom: 1px solid #e5e5e5;
    }
    .page__hd {
        /* padding: 0px; */
        padding: 0px 5px;
        padding-top: 10px;
        /* border: 1px solid #000; */
    }
    .page__title{
        margin-top: 5px;
        font-size: 20px;
        color: #333;
        text-align: center;
    }
    /* .weui-input{
      width:100%;
      border: 1px solid #e5e5e5;
      outline:0;
      -webkit-appearance:none;
      background-color:transparent;
      font-size:inherit;
      color:inherit;
      height:2em;
      line-height:2em;
    } */
</style>
<form name="form1" id="form1"  role="form" data-toggle="validator" method="POST" action="">

    <div class="page">
        <div class="page__hd">
            <div class="page__title">
                  {$title}
            </div>
            <!-- <div class="page__desc">
                  <span style="color: red">提醒：</span>为保证您和大家的健康安全，以下信息如有变动请及时更新！
            </div> -->
            <!-- <div class="page__desc">
                  <hr>
            </div> -->
        </div>

        <div class="page__bd">

            <div class="weui-cells weui-cells_form">
                <div class ="my-weui-cell">
                    <div class="weui-cells__title"><label class="weui-label">1.姓名</label></div>
                    <div class="weui-cell">
                        <div class="weui-cell__bd">
                            <input class="weui-input" type="text" required  name='row[nickname]' id='nickname' placeholder="请输入姓名" emptyTips="请输入姓名" >
                        </div>
                        <div class="weui-cell__ft">
                            <i class="weui-icon-warn"></i>
                        </div>
                    </div>
                </div>
                <div class ="my-weui-cell">
                    <div class="weui-cells__title">2.学号：</div>
                    <div class="weui-cell">
                        <div class="weui-cell__bd">
                            <input class="weui-input" name='row[sid]' id='sid' type="tel" required   placeholder="请输入学号" emptyTips="请输入学号" >
                        </div>
                        <div class="weui-cell__ft">
                            <i class="weui-icon-warn"></i>
                        </div>
                    </div>
                </div>
                <div class ="my-weui-cell">
                    <div class="weui-cells__title">3.手机号：</div>
                    <div class="weui-cell">
                        <div class="weui-cell__bd">
                            <input class="weui-input" type="tel" name='row[tel]' id='tel' required pattern="^\d{11}$" maxlength="11" placeholder="输入手机号" emptyTips="请输入手机号" notMatchTips="请输入正确的手机号">
                        </div>
                        <div class="weui-cell__ft">
                            <i class="weui-icon-warn"></i>
                        </div>
                    </div>
                </div>
                <div class ="my-weui-cell">
                    <div class="weui-cells__title"><label class="weui-label">4.性别</label></div>
                    <div class="weui-cells weui-cells_checkbox">
                        <label class="weui-cell weui-check__label" for="r1">
                            <div class="weui-cell__hd">
                                <input required type="radio" class="weui-check"  name="row[gender]" value="1" id="r1" tips="请选择性别">
                                <i class="weui-icon-checked"></i>
                            </div>
                            <div class="weui-cell__bd">男</div>
                        </label>
                       <label class="weui-cell weui-check__label" for="r2">
                            <div class="weui-cell__hd">
                                <input  type="radio" class="weui-check" name="row[gender]" value="2" id="r2" tips="请选择性别">
                                <i class="weui-icon-checked"></i>
                            </div>
                            <div class="weui-cell__bd">女</div>
                        </label>
                        <div class="weui-cell__ft">
                            <i class="weui-icon-warn"></i>
                        </div>
                    </div>
                </div>
                <div class ="my-weui-cell">
                    <div class="weui-cells__title">5.出生日期：</div>
                    <div class="weui-cell">
                        <div class="weui-cell__bd">
                            <input class="weui-input" name='row[birthday_time]' id='birthday_time' type="text" required  placeholder="请输入出生日期" emptyTips="请输入出生日期" >
                        </div>
                        <div class="weui-cell__ft">
                            <i class="weui-icon-warn"></i>
                        </div>
                    </div>
                </div>

                <div class ="my-weui-cell">
                    <div class="weui-cells__title">6.专业班级：</div>
                    <div class="weui-cell">
                        <div class="weui-cell__bd">
                            <input class="weui-input" type="text" required  id='classes_name' name='row[classes_name]' placeholder="班级" emptyTips="请输入班级" >
                            <input  type="hidden" required  id='year_' name='row[year_]' >
                            <input  type="hidden" required  id='classes_id' name='row[classes_id]' >
                        </div>
                        <div class="weui-cell__ft">
                            <i class="weui-icon-warn"></i>
                        </div>
                    </div>
                </div>

                <div class ="my-weui-cell">
                    <div class="weui-cells__title">7.家庭地址：</div>
                     <div class="weui-cell">
                        <div class="weui-cell__bd">
                            <input class="weui-input city-picker" type="text" required name='row[family_address]' id='family_address' placeholder="请选择" emptyTips="家庭所在地" >
                            <input  type="hidden" required  id='family_province_code' name='row[family_province_code]' >
                            <input  type="hidden" required  id='family_city_code' name='row[family_city_code]' >
                            <input  type="hidden" required  id='family_district_code' name='row[family_district_code]' >
                        </div>
                        <div class="weui-cell__ft">
                            <i class="weui-icon-warn"></i>
                        </div>
                    </div>
                </div>
                <div class ="my-weui-cell">
                    <div class="weui-cells__title">7.1.家庭具体地址：</div>
                     <div class="weui-cell">
                        <div class="weui-cell__bd">
                            <input class="weui-input" type="text" required name='row[family_address_detail]' id='family_address_detail' placeholder="（具体到小区/村）" emptyTips="家庭所在地" >
                        </div>
                        <div class="weui-cell__ft">
                            <i class="weui-icon-warn"></i>
                        </div>
                    </div>
                </div>
                <div class ="my-weui-cell">
                    <div class="weui-cells__title">8.当前地址：</div>
                    <div class="weui-cell">
                        <div class="weui-cell__bd">
                            <input class="weui-input city-picker" type="text" required  name='row[current_address]' id='current_address' placeholder="请选择当前地址" emptyTips="当前所在地" >
                            <input  type="hidden" required  id='current_province_code' name='row[current_province_code]' >
                            <input  type="hidden" required  id='current_city_code' name='row[current_city_code]' >
                            <input  type="hidden" required  id='current_district_code' name='row[current_district_code]' >
                        </div>
                        <div class="weui-cell__ft">
                            <i class="weui-icon-warn"></i>
                        </div>
                    </div>
                </div>
                <div class ="my-weui-cell">
                    <div class="weui-cells__title">8.1.当前具体地址：</div>
                     <div class="weui-cell">
                        <div class="weui-cell__bd">
                            <input class="weui-input" type="text" required name='row[current_address_detail]' id='current_address_detail' placeholder="（具体到小区/村）" emptyTips="当前所在地" >
                        </div>
                        <div class="weui-cell__ft">
                            <i class="weui-icon-warn"></i>
                        </div>
                    </div>
                </div>
                <div class ="my-weui-cell">
                    <div class="weui-cells__title">9.近15日内是否有乘坐1小时以上密闭公共交通经历？</div>
                    <div class="weui-cells weui-cells_checkbox">
                         <label class="weui-cell weui-check__label" for="r_a9_1">
                            <div class="weui-cell__hd">
                                <input required type="radio" class="weui-check " name="row[a_9]" value="1" id="r_a9_1" tips="请对第9题做出选择" >
                                <i class="weui-icon-checked"></i>
                            </div>
                            <div class="weui-cell__bd">是</div>
                        </label>
                       <label class="weui-cell weui-check__label" for="r_a9_2">
                            <div class="weui-cell__hd">
                                <input type="radio" class="weui-check"  name="row[a_9]" value="0" id="r_a9_2" >
                                <i class="weui-icon-checked"></i>
                            </div>
                            <div class="weui-cell__bd">否</div>
                        </label>
                    </div>
                </div>

                <div class ="my-weui-cell">
                    <div class="weui-cells__title">10.自1月10日以来是否有武汉进出经历或接触湖北疫区？</div>
                    <div class="weui-cells weui-cells_checkbox">
                         <label class="weui-cell weui-check__label" for="r_a10_1">
                            <div class="weui-cell__hd">
                                <input required type="radio" class="weui-check" name="row[a_10]" value="1" id="r_a10_1" tips="请对第10题做出选择">
                                <i class="weui-icon-checked"></i>
                            </div>
                            <div class="weui-cell__bd">是</div>
                        </label>
                       <label class="weui-cell weui-check__label" for="r_a10_2">
                            <div class="weui-cell__hd">
                                <input required type="radio"  class="weui-check"  name="row[a_10]" value="0" id="r_a10_2">
                                <i class="weui-icon-checked"></i>
                            </div>
                            <div class="weui-cell__bd">否</div>
                        </label>
                    </div>
                </div>
                <div id="a_10" style="display: none">
                    <div class ="my-weui-cell">
                        <div class="weui-cells__title">10.1. 进入武汉或湖北疫区日期:</div>
                        <div class="weui-cell">
                             <div class="weui-cell__bd">
                                <input class="weui-input datetime-picker" name='row[a_10_1]' id='a_10_1' type="text"  disabled placeholder="请输入日期" emptyTips="请输入日期" >
                            </div>
                            <div class="weui-cell__ft">
                                <i class="weui-icon-warn"></i>
                            </div>
                        </div>
                    </div>
                    <div class ="my-weui-cell">
                        <div class="weui-cells__title">10.2. 离开武汉或湖北疫区日期：</div>
                        <div class="weui-cell ">
                             <div class="weui-cell__bd">
                                <input class="weui-input datetime-picker" name='row[a_10_2]' id='a_10_2'  type="text"  disabled placeholder="请填写日期" emptyTips="请填写日期" >
                            </div>
                            <div class="weui-cell__ft">
                                <i class="weui-icon-warn"></i>
                            </div>
                        </div>
                    </div>
                    <div class ="my-weui-cell">
                        <div class="weui-cells__title">10.3. 退出原因</div>
                        <div class="weui-cell">
                            <div class="weui-cell__bd">
                                <textarea name="row[a_10_3]" id='a_10_3' disabled class="weui-textarea "   disabled placeholder="请填写原因" emptyTips="请填写原因"></textarea>

                            </div>
                            <div class="weui-cell__ft">
                                <i class="weui-icon-warn"></i>
                            </div>
                        </div>
                    </div>
                    <div class ="my-weui-cell">
                        <div class="weui-cells__title">10.4. 交通方式（含车次、航班号）</div>
                        <div class="weui-cell">
                            <div class="weui-cell__bd">
                               <input class="weui-input" type="text"  disabled name='row[a_10_4]' id='a_10_4' placeholder="请输入交通方式" emptyTips="请输入交通方式" >

                            </div>
                            <div class="weui-cell__ft">
                                <i class="weui-icon-warn"></i>
                            </div>
                        </div>
                    </div>
                    <div class ="my-weui-cell">
                        <div class="weui-cells__title">10.5.目前自己及身边亲人身体状况是否出现异常？</div>
                        <div class="weui-cells weui-cells_checkbox">
                             <label class="weui-cell weui-check__label" for="r_a10.5_1">
                                <div class="weui-cell__hd">
                                    <input  type="radio" class="weui-check" disabled name="row[a_10_5]" value="1" id="r_a10.5_1" tips="请对第10.5题做出选择">
                                    <i class="weui-icon-checked"></i>
                                </div>
                                <div class="weui-cell__bd">是</div>
                            </label>
                           <label class="weui-cell weui-check__label" for="r_a10.5_2">
                                <div class="weui-cell__hd">
                                    <input  type="radio"  class="weui-check" disabled  name="row[a_10_5]" value="0" id="r_a10.5_2">
                                    <i class="weui-icon-checked"></i>
                                </div>
                                <div class="weui-cell__bd">否</div>
                            </label>
                        </div>
                    </div>

                    <div class ="my-weui-cell">
                        <div class="weui-cells__title">10.6.是否汇报当地居委会/村委会？</div>
                        <div class="weui-cells weui-cells_checkbox">
                             <label class="weui-cell weui-check__label" for="r_a10.6_1">
                                <div class="weui-cell__hd">
                                    <input  type="radio" class="weui-check"  disabled name="row[a_10_6]" value="1" id="r_a10.6_1" tips="请对第10.6题做出选择">
                                    <i class="weui-icon-checked"></i>
                                </div>
                                <div class="weui-cell__bd">是</div>
                            </label>
                           <label class="weui-cell weui-check__label" for="r_a10.6_2">
                                <div class="weui-cell__hd">
                                    <input  type="radio"  class="weui-check"  disabled name="row[a_10_6]" value="0" id="r_a10.6_2">
                                    <i class="weui-icon-checked"></i>
                                </div>
                                <div class="weui-cell__bd">否</div>
                            </label>
                        </div>
                    </div>
                </div>
                <div class ="my-weui-cell">
                    <div class="weui-cells__title">11.是否近15日从湖北疫区抵达青岛？</div>
                    <div class="weui-cells weui-cells_checkbox">
                         <label class="weui-cell weui-check__label" for="r_a11_1">
                            <div class="weui-cell__hd">
                                <input required type="radio" class="weui-check" name="row[a_11]" value="1" id="r_a11_1" tips="请对第11题做出选择">
                                <i class="weui-icon-checked"></i>
                            </div>
                            <div class="weui-cell__bd">是</div>
                        </label>
                       <label class="weui-cell weui-check__label" for="r_a11_2">
                            <div class="weui-cell__hd">
                                <input  type="radio"  class="weui-check"  name="row[a_11]" value="0" id="r_a11_2">
                                <i class="weui-icon-checked"></i>
                            </div>
                            <div class="weui-cell__bd">否</div>
                        </label>
                    </div>
                </div>
                <div id="a_11" style="display: none">
                    <div class ="my-weui-cell">
                        <div class="weui-cells__title">11.1. 抵达日期:</div>
                        <div class="weui-cell">
                             <div class="weui-cell__bd">
                                <input class="weui-input datetime-picker" name='row[a_11_1]' id='a_11_1' type="text"  disabled placeholder="请输入抵达日期" emptyTips="请输入抵达日期" >
                            </div>
                            <div class="weui-cell__ft">
                                <i class="weui-icon-warn"></i>
                            </div>
                        </div>
                    </div>

                    <div class ="my-weui-cell">
                        <div class="weui-cells__title">11.2. 交通方式（含车次、航班号）</div>
                        <div class="weui-cell">
                            <div class="weui-cell__bd">
                               <input class="weui-input" type="text"  disabled name='row[a_11_2]' id='a_11_2' placeholder="请输入交通方式" emptyTips="请输入交通方式" >
                            </div>
                            <div class="weui-cell__ft">
                                <i class="weui-icon-warn"></i>
                            </div>
                        </div>
                    </div>

                    <div class ="my-weui-cell">
                        <div class="weui-cells__title">11.3.是否在居家隔离？</div>
                        <div class="weui-cells weui-cells_checkbox">
                             <label class="weui-cell weui-check__label" for="r_a11.3_1">
                                <div class="weui-cell__hd">
                                    <input  type="radio" class="weui-check" checked disabled name="row[a_11_3]" value="1" id="r_a11.3_1" tips="请对第11.3题做出选择">
                                    <i class="weui-icon-checked"></i>
                                </div>
                                <div class="weui-cell__bd">是</div>
                            </label>
                           <label class="weui-cell weui-check__label" for="r_a11.3_2">
                                <div class="weui-cell__hd">
                                    <input  type="radio"  class="weui-check"  disabled name="row[a_11_3]" value="0" id="r_a11.3_2">
                                    <i class="weui-icon-checked"></i>
                                </div>
                                <div class="weui-cell__bd">否</div>
                            </label>
                        </div>
                    </div>
                    <div class ="my-weui-cell">
                        <div class="weui-cells__title">11.4.自己及身边亲人身体是否出现异常？</div>
                        <div class="weui-cells weui-cells_checkbox">
                             <label class="weui-cell weui-check__label" for="r_a11.4_1">
                                <div class="weui-cell__hd">
                                    <input  type="radio" class="weui-check" disabled name="row[a_11_4]" value="1" id="r_a11.4_1" tips="请对第11.4题做出选择">
                                    <i class="weui-icon-checked"></i>
                                </div>
                                <div class="weui-cell__bd">是</div>
                            </label>
                           <label class="weui-cell weui-check__label" for="r_a11.4_2">
                                <div class="weui-cell__hd">
                                    <input  type="radio"  class="weui-check" disabled name="row[a_11_4]" value="0" id="r_a11.4_2">
                                    <i class="weui-icon-checked"></i>
                                </div>
                                <div class="weui-cell__bd">否</div>
                            </label>
                        </div>
                    </div>
                    <div class ="my-weui-cell">
                        <div class="weui-cells__title">11.5.是否汇报当地居委会/村委会？</div>
                        <div class="weui-cells weui-cells_checkbox">
                             <label class="weui-cell weui-check__label" for="r_a11.5_1">
                                <div class="weui-cell__hd">
                                    <input  type="radio" class="weui-check" disabled checked name="row[a_11_5]" value="1" id="r_a11.5_1" tips="请对第11.5题做出选择">
                                    <i class="weui-icon-checked"></i>
                                </div>
                                <div class="weui-cell__bd">是</div>
                            </label>
                           <label class="weui-cell weui-check__label" for="r_a11.5_2">
                                <div class="weui-cell__hd">
                                   <input  type="radio" class="weui-check"  disabled name="row[a_11_5]" value="0" id="r_a11.5_2" >
                                    <i class="weui-icon-checked"></i>
                                </div>
                                <div class="weui-cell__bd">否</div>
                            </label>
                        </div>
                    </div>

                </div>

                <div class ="my-weui-cell">
                    <div class="weui-cells__title">12.是否近15日从省外抵达山东？</div>
                    <div class="weui-cells weui-cells_checkbox">
                         <label class="weui-cell weui-check__label" for="r_a12_1">
                            <div class="weui-cell__hd">
                                <input type="radio" required name="row[a_12]" class="weui-check"  value="1" id="r_a12_1" tips="请对第12题做出选择">
                                <i class="weui-icon-checked"></i>
                            </div>
                            <div class="weui-cell__bd">是</div>
                        </label>
                       <label class="weui-cell weui-check__label" for="r_a12_2">
                            <div class="weui-cell__hd">
                                <input type="radio"  name="row[a_12]"   class="weui-check" value="0" id="r_a12_2">
                                <i class="weui-icon-checked"></i>
                            </div>
                            <div class="weui-cell__bd">否</div>
                        </label>
                    </div>
                </div>
                <div id="a_12" style="display: none">

                    <div class ="my-weui-cell">
                        <div class="weui-cells__title">12.1. 抵达日期:</div>
                        <div class="weui-cell">
                             <div class="weui-cell__bd">
                                <input class="weui-input datetime-picker" name='row[a_12_1]' id='a_12_1' type="text"  disabled placeholder="请输入抵达日期" emptyTips="请输入抵达日期" >
                            </div>
                            <div class="weui-cell__ft">
                                <i class="weui-icon-warn"></i>
                            </div>
                        </div>
                    </div>

                    <div class ="my-weui-cell">
                        <div class="weui-cells__title">12.2. 交通方式（含车次、航班号）</div>
                        <div class="weui-cell">
                            <div class="weui-cell__bd">
                               <input class="weui-input" type="text"  disabled name='row[a_12_2]' id='a_12_2' placeholder="请输入交通方式" emptyTips="请输入交通方式" >
                            </div>
                            <div class="weui-cell__ft">
                                <i class="weui-icon-warn"></i>
                            </div>
                        </div>
                    </div>

                    <div class ="my-weui-cell">
                        <div class="weui-cells__title">12.3.是否在居家隔离？</div>
                        <div class="weui-cells weui-cells_checkbox">
                             <label class="weui-cell weui-check__label" for="r_a12.3_1">
                                <div class="weui-cell__hd">
                                    <input  type="radio" name="row[a_12_3]" class="weui-check" disabled  value="1" id="r_a12.3_1" tips="请对第12.3题做出选择">
                                    <i class="weui-icon-checked"></i>
                                </div>
                                <div class="weui-cell__bd">是</div>
                            </label>
                           <label class="weui-cell weui-check__label" for="r_a12.3_2">
                                <div class="weui-cell__hd">
                                    <input  type="radio"  name="row[a_12_3]"  disabled class="weui-check" value="0" id="r_a12.3_2">
                                    <i class="weui-icon-checked"></i>
                                </div>
                                <div class="weui-cell__bd">否</div>
                            </label>
                        </div>
                    </div>
                    <div class ="my-weui-cell">
                        <div class="weui-cells__title">12.4.自己及身边亲人身体是否出现异常？</div>
                        <div class="weui-cells weui-cells_checkbox">
                             <label class="weui-cell weui-check__label" for="r_a12.4_1">
                                <div class="weui-cell__hd">
                                    <input  type="radio" name="row[a_12_4]" class="weui-check" disabled value="1" id="r_a12.4_1" tips="请对第12.4题做出选择">
                                    <i class="weui-icon-checked"></i>
                                </div>
                                <div class="weui-cell__bd">是</div>
                            </label>
                           <label class="weui-cell weui-check__label" for="r_a12.4_2">
                                <div class="weui-cell__hd">
                                    <input  type="radio"  name="row[a_12_4]"  disabled class="weui-check" value="0" id="r_a12.4_2">
                                    <i class="weui-icon-checked"></i>
                                </div>
                                <div class="weui-cell__bd">否</div>
                            </label>
                        </div>
                    </div>
                    <div class ="my-weui-cell">
                        <div class="weui-cells__title">12.5.是否汇报当地居委会/村委会？</div>
                        <div class="weui-cells weui-cells_checkbox">
                             <label class="weui-cell weui-check__label" for="r_a12.5_1">
                                <div class="weui-cell__hd">
                                    <input  type="radio" name="row[a_12_5]" class="weui-check" disabled  value="1" id="r_a12.5_1" tips="请对第12.5题做出选择">
                                    <i class="weui-icon-checked"></i>
                                </div>
                                <div class="weui-cell__bd">是</div>
                            </label>
                           <label class="weui-cell weui-check__label" for="r_a12.5_2">
                                <div class="weui-cell__hd">
                                    <input  type="radio"  name="row[a_12_5]"  disabled class="weui-check" value="0" id="r_a12.5_2">
                                    <i class="weui-icon-checked"></i>
                                </div>
                                <div class="weui-cell__bd">否</div>
                            </label>
                        </div>
                    </div>
                </div>

                <div class ="my-weui-cell">
                    <div class="weui-cells__title">13.近15日内是否接触过确诊病例？</div>
                    <div class="weui-cells weui-cells_checkbox">
                         <label class="weui-cell weui-check__label" for="r_a13_1">
                            <div class="weui-cell__hd">
                                <input required type="radio" name="row[a_13]" class="weui-check"  value="1" id="r_a13_1" tips="请对第13题做出选择">
                                <i class="weui-icon-checked"></i>
                            </div>
                            <div class="weui-cell__bd">是</div>
                        </label>
                       <label class="weui-cell weui-check__label" for="r_a13_2">
                            <div class="weui-cell__hd">
                                <input  type="radio"  name="row[a_13]"   class="weui-check" value="0" id="r_a13_2">
                                <i class="weui-icon-checked"></i>
                            </div>
                            <div class="weui-cell__bd">否</div>
                        </label>
                    </div>
                </div>

                <div class ="my-weui-cell">
                    <div class="weui-cells__title">14.近15日内是否接触过疑似病例或从疫区返鲁人员？</div>
                    <div class="weui-cells weui-cells_checkbox">
                         <label class="weui-cell weui-check__label" for="r_a14_1">
                            <div class="weui-cell__hd">
                                <input required type="radio" name="row[a_14]" class="weui-check"  value="1" id="r_a14_1" tips="请对第14题做出选择">
                                <i class="weui-icon-checked"></i>
                            </div>
                            <div class="weui-cell__bd">是</div>
                        </label>
                       <label class="weui-cell weui-check__label" for="r_a14_2">
                            <div class="weui-cell__hd">
                                <input  type="radio"  name="row[a_14]"  class="weui-check" value="0" id="r_a14_2">
                                <i class="weui-icon-checked"></i>
                            </div>
                            <div class="weui-cell__bd">否</div>
                        </label>
                    </div>
                </div>

                <div class ="my-weui-cell">
                    <div class="weui-cells__title">15.近15日内直系亲属有无被确诊？</div>
                    <div class="weui-cells weui-cells_checkbox">
                         <label class="weui-cell weui-check__label" for="r_a15_1">
                            <div class="weui-cell__hd">
                                <input required type="radio" name="row[a_15]" id="r_a15_1" class="weui-check"  value="1"  tips="请对第15题做出选择">
                                <i class="weui-icon-checked"></i>
                            </div>
                            <div class="weui-cell__bd">是</div>
                        </label>
                       <label class="weui-cell weui-check__label" for="r_a15_2">
                            <div class="weui-cell__hd">
                                <input  type="radio" name="row[a_15]" id="r_a15_2"  class="weui-check" value="0">
                                <i class="weui-icon-checked"></i>
                            </div>
                            <div class="weui-cell__bd">否</div>
                        </label>
                    </div>
                </div>

                <div class ="my-weui-cell">
                    <div class="weui-cells__title">16.目前是否在岗实习实训？</div>
                    <div class="weui-cells weui-cells_checkbox">
                         <label class="weui-cell weui-check__label" for="r_a16_1">
                            <div class="weui-cell__hd">
                                <input required type="radio" name="row[a_16]" id="r_a16_1"  class="weui-check"  value="1"  tips="请对第16题做出选择">
                                <i class="weui-icon-checked"></i>
                            </div>
                            <div class="weui-cell__bd">是</div>
                        </label>
                       <label class="weui-cell weui-check__label" for="r_a16_2">
                            <div class="weui-cell__hd">
                                <input  type="radio" name="row[a_16]" id="r_a16_2"   class="weui-check" value="0">
                                <i class="weui-icon-checked"></i>
                            </div>
                            <div class="weui-cell__bd">否</div>
                        </label>
                    </div>
                </div>
                <div id="a_16" style="display: none">
                    <div class ="my-weui-cell">
                        <div class="weui-cells__title">16.1. 实习实训单位名称</div>
                        <div class="weui-cell">
                            <div class="weui-cell__bd">
                               <input class="weui-input" type="text"  disabled name='row[a_16_1]' id='a_16_1' placeholder="请输入实习实训单位名称" emptyTips="请输入实习实训单位名称" >
                            </div>
                            <div class="weui-cell__ft">
                                <i class="weui-icon-warn"></i>
                            </div>
                        </div>
                    </div>
                    <div class ="my-weui-cell">
                        <div class="weui-cells__title">16.2. 实习实训岗位</div>
                        <div class="weui-cell">
                            <div class="weui-cell__bd">
                               <input class="weui-input" type="text"  disabled name='row[a_16_2]' id='a_16_2' placeholder="请输入实习实训岗位" emptyTips="请输入实习实训岗位" >
                            </div>
                            <div class="weui-cell__ft">
                                <i class="weui-icon-warn"></i>
                            </div>
                        </div>
                    </div>
                    <div class ="my-weui-cell">
                        <div class="weui-cells__title">16.3. 实习实训所在地</div>
                        <div class="weui-cell">
                            <div class="weui-cell__bd">
                               <input class="weui-input" type="text"  disabled name='row[a_16_3]' id='a_16_3' placeholder="具体到县/区" emptyTips="请输入实习实训所在地" >
                            </div>
                            <div class="weui-cell__ft">
                                <i class="weui-icon-warn"></i>
                            </div>
                        </div>
                    </div>
                    <div class ="my-weui-cell">
                        <div class="weui-cells__title">16.4. 实习实训开始日期:</div>
                        <div class="weui-cell">
                             <div class="weui-cell__bd">
                                <input class="weui-input datetime-picker" disabled name='row[a_16_4]' id='a_16_4' type="text"   placeholder="请输入实习实训开始日期" emptyTips="请输入实习实训开始日期" >
                            </div>
                            <div class="weui-cell__ft">
                                <i class="weui-icon-warn"></i>
                            </div>
                        </div>
                    </div>

                    <div class ="my-weui-cell">
                        <div class="weui-cells__title">16.5. 实习实训结束日期:</div>
                        <div class="weui-cell">
                             <div class="weui-cell__bd">
                                <input class="weui-input datetime-picker" disabled name='row[a_16_5]' id='a_16_5' type="text"   placeholder="请输入实习实训结束日期" emptyTips="请输入实习实训结束日期" >
                            </div>
                            <div class="weui-cell__ft">
                                <i class="weui-icon-warn"></i>
                            </div>
                        </div>
                    </div>
                    <div class ="my-weui-cell">
                        <div class="weui-cells__title">16.6.目前是否在岗？</div>
                        <div class="weui-cells weui-cells_checkbox">
                             <label class="weui-cell weui-check__label" for="r_a16.6_1">
                                <div class="weui-cell__hd">
                                    <input  type="radio" name="row[a_16_6]" id="r_a16.6_1" disabled class="weui-check"  value="1"  tips="请对第16.6题做出选择">
                                    <i class="weui-icon-checked"></i>
                                </div>
                                <div class="weui-cell__bd">是</div>
                            </label>
                           <label class="weui-cell weui-check__label" for="r_a16.6_2">
                                <div class="weui-cell__hd">
                                    <input  type="radio" name="row[a_16_6]"  id="r_a16.6_2"  disabled class="weui-check" value="0">
                                    <i class="weui-icon-checked"></i>
                                </div>
                                <div class="weui-cell__bd">否</div>
                            </label>
                        </div>
                    </div>
                </div>
                <div class ="my-weui-cell">
                    <div class="weui-cells__title">17.本人是否有发烧、干咳、乏力等异常表现？</div>
                    <div class="weui-cells weui-cells_checkbox">
                         <label class="weui-cell weui-check__label" for="r_a17_1">
                            <div class="weui-cell__hd">
                                <input  type="radio" name="row[a_17]" id="r_a17_1" class="weui-check"  value="1"  tips="请对第17题做出选择">
                                <i class="weui-icon-checked"></i>
                            </div>
                            <div class="weui-cell__bd">是</div>
                        </label>
                       <label class="weui-cell weui-check__label" for="r_a17_2">
                            <div class="weui-cell__hd">
                                <input  type="radio" name="row[a_17]" id="r_a17_2"  class="weui-check" value="0">
                                <i class="weui-icon-checked"></i>
                            </div>
                            <div class="weui-cell__bd">否</div>
                        </label>
                    </div>
                </div>

                <input type="hidden" name="row[latitude]" id="latitude" value="">
                <input type="hidden" name="row[abc]" id="abc" value="">
                <input type="hidden" name="row[longitude]" id="longitude" value="">

                <input type="text" id="address" name="row[address]" value="" readonly>

                <!-- <a href="javascript:;" id="datePickerBtn" class="weui-btn weui-btn_default">DatePicker</a> -->
            </div>
            <div  style="margin-top: 15px;">
                <button id="formSubmitBtn" type="submit" class="weui-btn weui-btn_success">提交</button>
            </div>
        </div>
    </div>
</form>

<script src="https://res.wx.qq.com/open/js/jweixin-1.4.0.js" type="text/javascript" charset="utf-8"></script>
<script type="text/javascript" charset="utf-8">
    wx.config({$wxjs});
    wx.ready(function () {
        wx.getLocation({
            type: 'wgs84', // 默认为wgs84的gps坐标，如果要返回直接给openLocation用的火星坐标，可传入'gcj02'
            success: function (res) {
                var latitude = res.latitude; // 纬度，浮点数，范围为90 ~ -90
                var longitude = res.longitude; // 经度，浮点数，范围为180 ~ -180。
                //var speed = res.speed; // 速度，以米/每秒计
                //var accuracy = res.accuracy; // 位置精度
                $("#latitude").val(latitude);
                $("#abc").val(latitude);
                $("#longitude").val(longitude);


                $.ajax({
                    url: '/api/wechat/getaddress',
                    data: 'lon='+$("#longitude").val()+'&lat='+$("#abc").val(),
                    type: 'post',
                    dataType: 'json',
                    success: function (data, textStatus, xhr) {
                        if(data.code == 1){
                            $("#address").val(data.data.formatted_address);
                        }else{
                            $("#address").val('请开启定位');
                        }
                    },
                    error: function (xhr, textStatus, error) {
                    }
                });
            },
            cancel: function (res) {
                alert('请允许获取位置');
                window.location.reload();
            }

        });
    })

</script>